Provider Demographics
NPI:1073596185
Name:DE LEON, MELANIE (DMD)
Entity Type:Individual
Prefix:DR
First Name:MELANIE
Middle Name:
Last Name:DE LEON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:MELANIE
Other - Middle Name:DE LEON
Other - Last Name:ESPINOSA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:737 W CHILDS AVE
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95340-6805
Mailing Address - Country:US
Mailing Address - Phone:209-383-1848
Mailing Address - Fax:209-384-3966
Practice Address - Street 1:1717 LAS VEGAS ST
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95358-5500
Practice Address - Country:US
Practice Address - Phone:209-556-5044
Practice Address - Fax:209-566-5047
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41247122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABD3847615OtherDEA CERT